This review of the results from the International Collaborative LBBAP Study (I-CLAS Group) was discussed live and in person at the Asia Pacific Heart Rhythm Society 2024 meeting in Sydney, Australia. It is presented in collaboration with Heart Rhythm TV. https://www.hrsonline.org/education/TheLead https://www.heartrhythmjournal.com/article/S1547-5271(24)03330-7/abstract Host Disclosure(s): J. Jacobson: Honoraria/Speaking/Consulting: Zoll Medical, Abbott Medical, Vektor Medical, Stocks, Privately Held: Atlas 5D, Research: CardioFocus, Inc.   Contributor Disclosure(s): T. Bunch: Honoraria/Speaking/Consulting: Heart Rhythm Society, Pfizer, Inc, Research: Boehringer Ingelheim, Altathera, Abbott, Travel Costs: Biosense Webster A. Desai: Nothing to disclose.

William H. Sauer, MD, FHRS, CCDS, Brigham and Women's Hospital is joined by Sanjay Divakaran, MD, MPH, Brigham and Women's Hospital and Xiaoxiao Qian, MD, Brigham, and Women's Hospital to discuss the 18F-Fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/magnetic resonance (MR) can identify inflammation and fibrosis, which are high-risk features in cardiac sarcoidosis. https://www.hrsonline.org/education/TheLead https://doi.org/10.1016/j.hrthm.2024.09.011 Host Disclosure(s): W.Sauer: Honoraria/Speaking/Consulting: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific, Research: Medtronic   Contributor Disclosure(s): S. Divakaran: Honoraria/Speaking/Consulting: Kinevant Sciences X. Qian: Fellowship Support: Brigham and Women’s Hospital

This episode is a discussion of the paper entitled, "Catheter Ablation versus Advanced Therapy for Patients with Severe Heart Failure and Ventricular Electrical Storm." https://www.hrsonline.org/education/TheLead https://doi.org/10.1016/j.hrthm.2024.09.045 Host Disclosure(s): W.Sauer: Honoraria/Speaking/Consulting: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific, Research: Medtronic   Contributor Disclosure(s): R. Kerley: Nothing to disclose. A. Desai: Research: Novartis, Bayer Healthcare Pharmaceuticals, Abbott Medical, AstraZeneca, Honoraria/Speaking/Consulting: Novartis, Abbott, AstraZeneca, Regerneron, Alnylam Pharmaceuticals, Bayer Healthcare Pharmaceutricals, Cytokinetics, AxonTherapies, Avidity Biosciences, Medpace, Merck, New Amsterdam Pharma, Parexel, Roche Diagnostics, GlacoSmithKline, NovoNordisk, Veristat, Verily/Google, Zydus, River2Renal, Membership on Advisory Committees: BioFourmis

Join host Deepthy Varghese, MSN, ACNP, FNP, as she discusses Managing Data Overload: AI Wearables and Apps with article author Hawkins Gay, MD, MPH. This article was published simultaneously with HRX 2024, and the interview is brought to you live from the meeting in Atlanta, Georgia. https://www.hrsonline.org/education/TheLead https://www.heartrhythmjournal.com/article/S1547-5271(24)03114-X/abstract Host Disclosure(s): D. Varghese: Nothing to disclose.   Contributor Disclosure(s): H. Gay: Nothing to disclose.

In this episode of The Lead, brought to you live from HRX, Deepthy Varghese interviews author Sana Al-Khatib on two of her recent publications. https://www.hrsonline.org/education/TheLead https://www.heartrhythmjournal.com/article/S1547-5271(24)03110-2/abstract https://www.heartrhythmjournal.com/article/S1547-5271(24)02380-4/fulltext Host Disclosure(s): D. Varghese: Nothing to disclose.   Contributor Disclosure(s): S. Al-Khatib: Other Relationships: American Heart Association

Join us for another episode of The Lead! https://www.hrsonline.org/education/TheLead https://jamanetwork.com/journals/jama/article-abstract/2823283 Host Disclosure(s): J. Chyou: Honoraria/Speaking/Consulting: American Heart Association, McGraw Hill, Medtronic, Research: American Heart Association, Membership on Advisory Committees: American Heart Association   Contributor Disclosure(s): C. Cheung: Nothing to disclose. P. Sanders: Membership on Advisory Committees: Boston Scientific, Medtronic PLC, Pacemate, CathRx, Research: Abbott, Becton Dickinson, Boston Scientific, CathRx, Medtronic, Pacemate.

Moderated by Rebecca Yapejian with CardiacRMS, this podcast is a dynamic discussion between Jagmeet P. Singh, MD, PhD, FHRS and Suneet Mittal, MD, FHRS, on the current and future state of CIED Remote Monitoring for Electophysiologists. Faculty Suneet Mittal MD, FHRS Jagmeet Singh, MD, PhD, FHRS Rebecca Yapejian, BS, BSN, MSN, APRN, FNP, CCDS, CardiacRMS

Join moderator Melissa Middeldorp as she discusses the NEJM article Asundexian versus Apixaban in Patients with Atrial Fibrillation with Christopher C Cheung, MD, MPH and Prashanthan Sanders, MBBS, PhD, FHRS at HRS2024 in Atalnta. This episode is brought to you live from the HRSTV Studio and comes with bonus video footage. https://www.hrsonline.org/education/TheLead https://www.nejm.org/doi/full/10.1056/NEJMoa2407105 Host Disclosure(s): M. Middeldorp: Nothing to disclose.   Contributor Disclosure(s): C. Cheung: Nothing to disclose. P. Sanders: Membership on Advisory Committees: Boston Scientific, Medtronic PLC, Pacemate, CathRx, Research: Abbott, Becton Dickinson, Boston Scientific, CathRx, Medtronic, Pacemate.

Dr. Michael S. Lloyd, MD, FHRS, Emory University is joined by Lucas V. A. Boersma, MD, PhD, St Antonius Hospital, and Michael Hoskins, MD, New Mexico Heart Institute to discuss the Pulmonary Vein Isolation With or Without Left Atrial Appendage Ligation in Atrial Fibrillation The aMAZE Randomized Clinical Trial.   https://jamanetwork.com/journals/jama/fullarticle/2816924 https://www.hrsonline.org/education/TheLead Host Disclosure(s): M. Lloyd: Honoraria/Speaking/Consulting: Medtronic, Membership on Advisory Committees: Boston Scientific   Contributor Disclosure(s): L. Boersma: Honoraria/Speaking/Consulting: Boston Scientific, Adagio Medical, Medtronic, Honoraria/Speaking/Teaching: Acutus Medical, KODEX-EPD M. Hoskins: Nothing to disclose.

Niraj Sharma, MD, FHRS, Northside Hospital is joined by Rhea Pimentel, BChir, MD, FHRS, University of Kansas Health System and Usman Siddiqui, MD, Florida Cardiology Advent Health Systems, Orlando, to discuss how the FLUTFIB study aimed to assess the incidence, duration, timing, and symptoms of atrial fibrillation (AF) after cavotricuspid isthmus (CTI) ablation in patients with atrial flutter (AFL). The study included 100 patients with AFL, who received implantable loop recorders for continuous AF monitoring following CTI ablation. Over a median follow-up of 24 months, 77% of patients experienced AF episodes, typically occurring around 180 days post-ablation. Most AF episodes lasted over an hour, and about half of the patients reported symptoms. Baseline characteristics and risk scores (HATCH and CHA2DS2-VASc) did not predict AF development. Oral anticoagulation was discontinued in 32% of patients during follow-up but was restarted in 15% after AF detection. No strokes or transient ischemic attacks were recorded. This study, the largest of its kind, underscores the high incidence of often asymptomatic AF after AFL ablation and provides insights for anticoagulation management post-ablation.   https://www.hrsonline.org/education/TheLead Host Disclosure(s): N. Sharma: Nothing to disclose.   Contributor Disclosure(s): U. Siddiqui: Honoraria/Speaking/Teaching: Abbott Medical, Acutus Medical Inc., Impulse Dynamics USA R. Pimentel: Honoraria/Speaking/Consulting: American College of Cardiology Foundation, Honoraria/Speaking/Teaching: Medtronic, Boston Scientific, Abbott Medical, Membership on Advisory Boards: Biosense Webster This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode74

William H. Sauer, MD, FHRS, CCDS, Brigham and Women's Hospital is joined by Rod S. Passman, MD, FHRS, Northwestern University and Graham Peigh, MD, MS, Northwestern Memorial Hospital to discuss the direct oral anticoagulants (DOACs) reduce stroke risk in patients with device-detected atrial fibrillation (DD-AFib) but increase major bleeding risk. The time to benefit (TTB) and time to harm (TTH) are not well quantified.   https://www.hrsonline.org/education/TheLead https://www.heartrhythmjournal.com/article/S1547-5271(24)02812-1/fulltext#secsectitle0055 Host Disclosure(s): W. Sauer: Honoraria/Speaking/Consulting: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific, Research: Medtronic   Contributor Disclosure(s): G. Peigh:  Nothing to disclose R. Passman: Research: AHA Foundation Award, Abbott Medical, NIH/NHLBI, Apple Inc., Royalty Income: UpToDate, Inc, Honoraria/Speaking/Consulting: Janssen Pharmaceuticals, Boston Scientific, Membership on Advisory Committees: Medtronic, iRhythm Technologies This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode73

Deepthy Varghese, MSN, ACNP, FNP, Northside Hospital is joined by Hung-Fat Tse, Sr., MD, University of Hong Kong and Glenn Young, MBBS, Royal Adelaide Hospital to discuss the effectiveness of the PRECISE-DAPT score with the CHA2DS2VASC score in predicting thromboembolic risk in nonvalvular atrial fibrillation (AF) patients undergoing transesophageal echocardiography (TEE) before AF ablation. 428 patients were analyzed, with 60 in the thrombogenic positive group and 368 in the thrombogenic milieu negative group. Multivariate logistic regression revealed that the PRECISE-DAPT score independently predicted thrombogenic milieu presence (OR: 1.145, CI: 1.083–1.211, p   https://www.hrsonline.org/education/TheLead https://jafib-ep.com/journal/february-2024-volume-17-issue-1/original-research-the-predictive-value-of-precise-dapt-scores-for-thrombogenic-milieu-of-the-left-atrium-in-patients-awaiting-af-ablation/   Host Disclosure(s): D. Varghese: Nothing to disclose   Contributor Disclosure(s): H. Tse: Research: Abbott Medical, Medtronic Inc., Boston Scientific, AstraZeneca, Daiichi Sankyo, Pfizer/BMS, Amgen, Bayer Healthcare Pharmaceuticals, Sanofi, Conoraria/Speaking/Teaching: Abbott Medical, Medtronic Inc., Boston Scientific, AstraZeneca, Daiichi Sankyo, Pfizer/BMS, Amgen, Bayer Healthcare Pharmaceuticals, Sanofi, Boehringer Ingelheim, Biotronik G. Young: Nothing to disclose This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365     https://www.heartrhythm365.org/URL/TheLeadEpisode72

William H. Sauer, MD, FHRS, CCDS, Brigham and Women's Hospital is joined by Andrés Felipe Miranda-Arboleda, MD, Brigham and Women's Hospital Babak Nazer, MD, University of Washington to discuss how Purkinje fibers play an important role in the initiation and maintenance of ventricular fibrillation (VF) and polymorphic ventricular tachycardia (PMVT). Fascicular substrate modification (FSM) approaches have been suggested to treat recurrent VF in case reports and small case series. https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacep.2024.03.035 Host Disclosure(s): W. Sauer: Honoraria/Speaking/Consulting: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific, Research: Medtronic   Contributor Disclosure(s): A. Miranda-Arboleda: Nothing to disclose. B. Nazar: Honoraria/Speaking/Consulting: Biosense Webster, Boston Scientific, Edwards Lifesciences, Research: Biosense Webster This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode71

Michael S. Lloyd, MD, FHRS, Emory University, is joined by Jayanthi N. Koneru, MBBS, FHRS, VCU Medical Center, Cardiology, and S. Patrick Whalen, MD, FHRS, Wake Forest University, School of Medicine to discuss the practical applications of the updated guidelines and their impact on the global field of EP. https://www.hrsonline.org/education/TheLead https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11000153/ Host Disclosure(s): M. Lloyd: Honoraria/Speaking/Consulting: Medtronic, Baylis Medical Company, Boston Scientific.   Contributor Disclosure(s): J. Koneru: Honoraria/Speaking/Consulting: Medtronic, Abbott Medical, Baylis Medical Company, Biosense Webster, Inc., Research: Abbott Medical, Boston Scientific, Biosense Webster, Inc., Medtronic S. Whalen: Nothing to disclose.   This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode71

Deepthy Varghese, MSN, ACNP, FNP, Northside Hospital is joined by Sirena Bridges, MSN, FNP-BC, CCDS, VA Tennessee Valley Healthcare, and Jodie L. Hurwitz,  MD, FHRS, North Texas Heart Center to discuss the effects of metoprolol and carvedilol on the risk of atrial tachyarrhythmia (ATA) and ventricular arrhythmia (VA) in over 4,000 heart failure (HF) patients with a primary prevention implantable cardioverter-defibrillator (ICD) by pooling data from five landmark ICD trials. Carvedilol treatment was associated with a 35% reduction in the risk of ATA and a corresponding decrease in the risk of inappropriate ICD shocks when compared to metoprolol. While there was a trend towards a lower risk of fast VA with carvedilol, this finding did not reach statistical significance. Carvedilol's unique properties, including its ability to block both β and α receptors, improve hemodynamics, and exhibit antiarrhythmic effects, may contribute to its superior outcomes. Overall, these results suggest that carvedilol may be preferred as the first-line beta-blocker choice in HF patients with a primary prevention ICD, but further prospective studies are needed to validate these findings and assess the impact of contemporary HF therapies on arrhythmic outcomes https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacep.2023.06.009 Host Disclosure(s): D. Varghese: Nothing to disclose.   Contributor Disclosure(s): S. Bridges: Nothing to disclose. J. Hurwitz: Nothing to disclose.   This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode69

Jason T. Jacobson, MD, FHRS, Westchester Medical Center-New York Medical College is joined by Jose Carlos Pachon-Mateos, MD, PhD, Sao Paulo Heart Hospital, and Sunny S. Po, MD, PhD, FHRS, University of Oklahoma, Health Sciences Center to discuss the porcine model of cardioneuroablation is tested for vagal denervation effects at 6 weeks. The model is further tested for enhanced susceptibility to ventricular arrhythmias during myocardial ischemia of ablated animals. https://www.hrsonline.org/education/TheLead https://doi.org/10.1016/j.hrthm.2023.08.001 Host Disclosure(s): J. Jacobson: Honoraria/Speaking/Consulting: American College of Cardiology, Zoll Medical Corporation, Research: Abbott, Phillips, Stock, Privately Held: Atlas 5D   Contributor Disclosure(s): S. Po: Honoraria/Speaking/Consulting: Biosense Webster, Inc., Ownership: NanoMed Targeting System J. Pachon-Mateos: Ownership: Personalis, Research: University of Sao Paulo   This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode68

Deepthy Varghese, MSN, ACNP, FNP, Northside Hospital is joined by Tina Baykaner, MD, MPH Stanford University, and Gurukripa N Kowlgi, MBBS, MSci,  Mayo Clinic–Rochester to discuss; the multicenter study investigated the potential of machine learning (ML) models to improve risk stratification for implantable cardioverter-defibrillator (ICD) implantation in patients at risk of sudden cardiac death (SCD). By combining clinical variables with 12-lead electrocardiogram (ECG) time-series features, the models aimed to predict non-arrhythmic mortality within three years after device implantation. Results showed that ML models identified patients at risk with high accuracy, demonstrating robust performance in both the development and external validation cohorts. This suggests that ML-based approaches could enhance risk assessment for SCD prevention in primary prevention populations. https://www.hrsonline.org/education/TheLead https://academic.oup.com/europace/article/25/9/euad271/7274626 Host Disclosure(s): D. Varghese: Nothing to disclose   Contributor Disclosure(s): G. Kowlgi: Nothing to disclose T. Baykaner: Honoraria, Speaking, and Consulting: Medtronic Inc., Pacemate, Research: NIH   This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode67

William H. Sauer, MD, FHRS, CCDS, Brigham and Women's Hospital is joined by Edward P. Gerstenfeld, MD, MS, FHRS, University of California, San Francisco, and Yasser Rodriguez, MBA, MD, Cleveland Clinic Florida to discuss; Background: Premature ventricular complexes (PVCs) are common and associated with worse outcomes in patients with heart failure. Class 1C antiarrhythmic drugs (AADs) effectively suppress PVCs, but guidelines currently restrict their use in structural heart disease. Conclusions: Class 1C AADs effectively suppressed PVCs in patients with NICM and ICDs, leading to increases in LVEF and biventricular pacing percentage. In this limited sample, their use was safe. Larger studies are needed to confirm the safety of this approach.   https://www.hrsonline.org/education/TheLead https://doi.org/10.1016/j.jacep.2024.01.021 Host Disclosure(s): W. Sauer: Honoraria/Speaking/Consulting: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific, Research: Medtronic    Contributor Disclosure(s): E. Gerstenfeld: Honoraria/Speaking/Teaching: Abbott, Biosense Webster, Inc., Boston Scientific, Medtronic, Membership on Committees/Advisory Boards: Boston Scientific, Farapulse, Honoraria/Speaking/Consulting: Boston Scientific, Abbott Medical, Medtronic, Adagio Medical, Research: Boston Scientific Y. Rodriguez: Nothing to disclose.   This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365     https://www.heartrhythm365.org/URL/TheLeadEpisode66

Deepthy Varghese, MSN, ACNP, FNP, Northside Hospital is joined by James O'Hara, PhD, PA, Virginia Heart, and Shunmuga Sundaram Ponnusamy, MBBS, MD, CEPS-A, Velammal Medical College Hospital, and Research Institute to discuss a study that evaluated the impact of QRS morphology on the risk of life-threatening ventricular arrhythmias in heart failure patients treated with cardiac resynchronization therapy with a defibrillator (CRT-D). The analysis included 2,862 patients from five major ICD trials, focusing on those with a QRS duration of ≥130 ms. Patients were categorized into those receiving ICD-only or CRT-D. Key findings: Among patients with left bundle branch block (LBBB), those with CRT-D showed a significant 44% reduction in the risk of fast ventricular tachycardia (VT)/ventricular fibrillation (VF) compared to ICD-only patients. They also had a lower fast VT/VF burden and fewer appropriate shocks. In patients with non-left bundle branch block (NLBBB), CRT-D did not reduce the risk of fast VT/VF and was associated with a significant increase in the burden of fast VT/VF events compared to ICD-only patients. The study concludes that CRT-D effectively reduces life-threatening ventricular arrhythmias in LBBB patients but may increase the risk in NLBBB patients.    https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacep.2023.09.018?s=03 Host Disclosure(s): D. Varghese: Nothing to disclose.    Contributor Disclosure(s): J. O'Hara: Honoraria, Speaking, and Consulting: Medtronic Inc., Boston Scientific  S. Ponnusamy: Honoraria, Speaking, and Consulting: Medtronic Inc.

Danesh Kella, MBBS, FHRS, Mayo Clinic is joined by Michael S. Lloyd, MD, FHRS, Emory University, and Siva K. Mulpuru, MD, FHRS, Mayo Clinic to discuss how the authors utilized a post-approval registry for Micra leadless pacemakers and explored the long-term outcomes at 5 years. There were 1809 patients in the leadless pacemaker arm compared to a historical cohort of transvenous pacemakers with 2667 patients. The study found no leadless pacemaker removals due to infection. The overall complication rate at 60 months was 4.5%, and the system revision rate at 60 months was 4.9%. The major complication rate at 36 months was 4.5% in the leadless pacemaker arm, compared to an 8.5% rate observed in the transvenous arm (p   https://www.hrsonline.org/education/TheLead https://academic.oup.com/eurheartj/article/45/14/1241/7617133   Host Disclosure(s): D. Kella: Honoraria/Speaking/Consulting: Zoll Medical Company   Contributor Disclosure(s): M. Lloyd: Honoraria/Speaking/Consulting: Medtronic, Baylis Medical Company, Boston Scientific.  S. Mulpuru: Nothing to disclose.   This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode64

Deepthy Varghese, MSN, ACNP, FNP, Northside Hospital is joined by Aarti Dalal, DO, FHRS, CEPS-P, Vanderbilt University and Peter S. Fischbach, MA, MD, Emory University/Children's Healthcare of Atlanta to discuss the multicenter, single-arm trial evaluated the safety and efficacy of transplacental treatment for fetal supraventricular tachycardia (SVT) and atrial flutter (AFL). The treatment involved using digoxin, sotalol, and flecainide for singleton pregnancies from 22 to less than 37 weeks of gestation with sustained fetal SVT or AFL with heart rates of at least 180 beats per minute. Out of the 50 enrolled patients, fetal tachyarrhythmia resolved in 89.8% of cases overall, and in 75.0% of cases where fetal hydrops were present. Pre-term births occurred in 20.4% of patients. Maternal adverse events were observed in 78.0% of patients, with serious adverse events leading to discontinuation of treatment in 4 patients. Two fetal deaths occurred due to heart failure, and neonatal tachyarrhythmia was observed in 31.9% of neonates within 2 weeks after birth. In conclusion, the transplacental treatment protocol was effective and tolerable in 90% of patients, but serious adverse events were noted in fetuses, and tachyarrhythmias could recur in neonates within the first 2 weeks after birth.   https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacc.2019.06.024   Host Disclosure(s): D. Varghese: Nothing to disclose   Contributor Disclosure(s): A. Dalal: Honoraria, Speaking, and Consulting: Medtronic Inc. P. Fischbach: Nothing to disclose   This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode63

The Lead is a journal review podcast designed to keep listeners up to date and informed on the latest publications and hottest topics in electrophysiology. The Lead’s session at Heart Rhythm 2024 includes three discussions, covering Transvenous Extraction of Conduction System Pacing Leads: An International Multicenter (TECSPAM) study and Safety, Efficacy, and Reliability Evaluation of a Novel Small-Diameter Defibrillation Lead: Global LEADR Pivotal Trial Results from the May 2024 issue of Heart Rhythm Journal, as well as Tachycardia therapy and Endpoint Results of the First Modular, Intra-body, Communicating Subcutaneous Defibrillator-Leadless Pacemaker System: MODULAR ATP Interim Cohort from the May 2024 issue of the New England Journal of Medicine. Join us for a lively and informative discussion!   https://www.hrsonline.org/education/TheLead   Host Disclosure(s): C. Cheung: Research: Abbott, Speaking/Teaching: Biosense Webster, Abbott, Biotronik D. Kella: Speakering, Teaching, and Consulting: Zoll Medical Corporation D. Varghese: Nothing to disclose   Contributor Disclosure(s): C. Rinaldi: Research: Abbott, Medtronic, Boston Scientific, LivaNova, Membership on Advisory Committees: EBR Systems, Speaking and Teaching: Spectranetics Corporation M. Leal: Speaking and Teaching: Sanofi, Research: Medtronic R. Pathak: Nothing to disclose. M. Chelu: Research: Impulse Dynamics USA, Abbott, PCORI, NIH/NHLBI, Speaking and Teaching: Impulse Synamics USA A.  Amin: Speaking, Teaching, and Consulting: Medtronic, Boston Scientific, Philips E. Zeitler: Research: Sanofi, Bionsense Webster, Inc., Speaking, Teaching, and Consulting: Biosense Webster, Inc., Boston Scientific, Element Science, Inc., Membership on Advisory Committees: Medtronic

Bruce A. Koplan, MD, MPH, FHRS, Brigham Women's Hospital is joined by Matthew R. Reynolds, MD, MS, FHRS, Lahey Hospital & Medical Center, and Esseim Sharma, MD, University Hospitals Cleveland to discuss integrating patient-specific cardiac implantable electronic device (CIED)-detected atrial fibrillation (AF) burden with measures of health care cost and utilization allows for an accurate assessment of the AF-related impact on health care use.  https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/full/10.1016/j.jacep.2023.12.011 Host Disclosure(s): B. Koplan: Speaking/Consulting Honoraria: GE Healthcare Contributor Disclosure(s): M. Reynolds: Speaking, Teaching, and Consulting: Medtronic, Edwards Lifesciences, Philips, iRhythm Technologies, Membership on Advisory Committees: Affera, Inc. E. Sharma: Nothing to disclose. This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365     https://www.heartrhythm365.org/URL/TheLeadEpisode61

Deepthy Varghese, MSN, ACNP, FNP, Northside Hospital, is joined by Shephal K Doshi, MD Pacific Heart Institute, and Devi G. Nair, MD, FHRS, St. Bernards Medical Center & Arrhythmia Research Group to discuss how the retrospective cohort study examined the safety and efficacy of combining left atrial appendage occlusion (LAAO) with other cardiac procedures compared to isolated LAAO. Based on data from the National Inpatient Sample database, the analysis found similar rates of major adverse cardiovascular events (MACEs) and length of stay (LOS) between the two groups. However, patients undergoing concomitant procedures had higher costs and certain complications were more frequent, such as heart block with atrial fibrillation/atrial flutter ablation and stroke with transcatheter aortic valve replacement.    https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jcin.2023.10.017   Host Disclosure(s): D. Varghese: Nothing to disclose.   Contributor Disclosure(s): S. Doshi: Research: Biosense Webster, Inc., Abbott Medical, Boston Scientific, Galvanize Therapeutics D. Nair: Honoraria, Speaking, and Consulting: Medtronic, Biosense Webster, Inc., Boston Scientific, Abbott Medical This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode60

Jason T. Jacobson, MD, FHRS, Westchester Medical Center-New York Medical College, is joined by William H. Sauer, MD, FHRS, Brigham and Women's Hospital, and Christian Thomas Ruff, MD, Brigham and Women's Hospital to discuss a meta-analysis of the 2 recent randomized controlled trials of oral anticoagulation vs aspirin and placebo for atrial high rate episodes detected by cardiac implanted electronic devices. The trials included are NOAH-AFNET6 and ARTESIA, which reported discordant results. When analyzed together, this study shows that anticoagulation does decrease embolic risk in this patient population.   https://www.hrsonline.org/education/TheLead https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.067512   Host Disclosure(s): J. Jacobson: Honoraria/Speaking/Consulting: American College of Cardiology, Zoll Medical Corporation, Research: Abbott, Phillips, Stock, Privately Held: Atlas 5D   Contributor Disclosure(s): C. Ruff: Honoraria/Speaking/Consulting: Bayer Healthcare Pharmaceuticals, Janssen Pharmaceuticals, Daiichi, Boehringer Ingelheim, Bristol-Myers Squibb, Portola Pharmaceuticals, Research: Daiichi, MedImmune W. Sauer: Honoraria/Speaking/Consulting: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific, Research: Medtronic 

Janice Y. Chyou, MD, FHRS, Icahn School of Medicine at Mount Sinai, is joined by Fred M. Kusumoto, MD, FHRS, Mayo Clinic Jacksonville, and Julia H. Indik, MD, PhD, FHRS, University of Arizona Medical Center (CVD) to discuss how Atrial fibrillation (AF) is a chronic progressive disorder. Persistent forms of AF are associated with increased rates of thromboembolism, heart failure, and death. Catheter ablation modifies the pathogenic mechanism of AF progression. No randomized studies have evaluated the impact of the ablation energy on progression to persistent atrial tachyarrhythmia.    https://www.hrsonline.org/education/TheLead https://doi.org/10.1093/eurheartj/ehad572   Host Disclosure(s): J. Chyou: Honoraria/Speaking/Consulting: McGraw-Hill, American Heart Association, Membership, Advisory Committee: American Heart Association   Contributor Disclosure(s): J. Indik: Honoraria, Other Financial Relationships: American College of Cardiology, Honoraria/Speaking/Consulting: Heart Rhythm Society F. Kusumoto: Nothing to disclose   This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365: https://www.heartrhythm365.org/URL/TheLeadEpisode58

Michael S. Lloyd, MD, FHRS, Emory University, is joined by guest Christopher R. Ellis, MD, FHRS, Vanderbilt Heart, and Stacy B. Westerman, MD, MPH, Emory University, to discuss Esophageal deviation devices for AF Ablation. https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacep.2023.09.004#:~:text=The%20EASY%20AF%20trial%20(EsophAguS,esophageal%20lesions%20attributable%20to%20RFA Host Disclosure(s): M. Lloyd: Honoraria/Speaking/Consulting: Medtronic, Baylis Medical Company, Boston Scientific Contributor Disclosure(s): C. Ellis: Honoraria/Speaking/Consulting: Boston Scientific, Abbott Medical, Research: Medtronic, Boehringer Ingelheim S. Westerman: Honoraria/Speaking/Consulting: Boston Scientific  This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365     https://www.heartrhythm365.org/URL/TheLeadEpisode57

William H. Sauer, MD, FHRS, CCDS, Brigham and Women's Hospital is joined by guest Amin Al-Ahmad, MD, FHRS, CCDS, Texas Cardiac Arrhythmia Institute and Jorge Romero, Jr., MD, FHRS, Brigham and Women's Hospital to discuss how Pulsed-field ablation (PFA) is a novel nonthermal ablation technology with high procedural safety and efficiency for pulmonary vein isolation (PVI). Premarket data showed high PVI durability during mandatory remapping studies. Data on lesion durability in real-world patients with clinically indicated redo procedures are scarce. In this episode of The Lead, we discuss why and how this study sought to report PVI durability rates in patients undergoing a clinically indicated redo procedure after an index PVI using PFA. https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacep.2023.11.026 Host Disclosure(s): W. Sauer: Honoraria/Speaking/Consulting: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific, Research: Medtronic Contributor Disclosure(s): A. Al-Ahmad: Honoraria/Speaking/Consulting: Abbott, Biosense Webster, Inc., Boston Scientific, Haemonetics, Mediasphere Medical, Medtronic, Philips, Stocks, Privately Held: Soundcath J. Romero: Honoraria/Speaking/Consulting: Sanofi, Boston Scientific, AtriCure, Inc.

Janice Y. Chyou, MD, FHRS, Icahn School of Medicine at Mount Sinai, is joined by guest Christine M. Albert, MD, MPH, FHRS, Cedars-Sinai Medical Center and Marina Cerrone, MD, NYU School of Medicine to discuss how Electrocardiogram (ECG) abnormalities have been evaluated as static risk markers for sudden cardiac death (SCD), but the potential importance of dynamic ECG remodeling has not been investigated. In this study, the nature and prevalence of dynamic ECG remodeling were studied among individuals who eventually suffered SCD. https://www.hrsonline.org/education/TheLead https://pubmed.ncbi.nlm.nih.gov/37956651/ Host Disclosure(s): J. Chyou: Honoraria/Speaking/Consulting: McGraw-Hill, American Heart Association, Membership, Advisory Committee: American Heart Association Contributor Disclosure(s): C. Albert: Research: Abbott, Roche Diagnostics, St. Jude Medical, NIH, Honoraria/Speaking/Consulting: Boston Scientific, Medtronic, Element Services, Inc., Illumina, Novartis M. Cerrone: Research: American Heart Association, Honoraria/Speaking/Consulting: StrideBio, Medtronic Inc., BioMarin, Inc., Abbott Medical This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode55

Deepthy Varghese, MSN, ACNP, FNP, Northside Hospital, is joined by Gregory Lip, MD., University of Liverpool, and Elaine Y. Wan, MD, FHRS Columbia University, Cardiology to discuss the limitations of current clinical decision tools for assessing bleeding risk in individuals with atrial fibrillation (AF) taking direct-acting oral anticoagulants (DOACs). Conducted as a secondary analysis of the RE-LY trial and validated in multiple cohorts, the study introduces the DOAC Score as a personalized risk assessment tool. The DOAC Score incorporates various covariates such as age, creatinine clearance, underweight status, medical history, and medication use to estimate the comparative risk for major bleeding. The risk prediction model demonstrated robust performance, outperforming the HAS-BLED score in terms of predictive accuracy. Internal and external validation in diverse cohorts, including the GARFIELD-AF registry, COMBINE-AF pooled clinical trial cohort, and administrative databases, confirmed the score's reliability in stratifying bleeding risk among individuals on different DOACs. The DOAC Score represents a significant advancement in tailoring risk assessments for bleeding in AF patients receiving DOAC therapy, contributing to more informed clinical decision-making.  https://www.hrsonline.org/education/TheLead https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.064556 Host Disclosure(s): D. Varghese: No relevant financial relationships with ineligible companies to disclose. Contributor Disclosure(s): G. Lip: Honoraria, Speaking, and Consulting: Bristol-Myers Squibb, Pfizer, Inc., Daiichi  E. Wan: Honoraria, Speaking, and Consulting: Medtronic, National Institutes for Health, Sanofi, Boston Scientific, Research: Zoll Medical Corp. This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365     https://www.heartrhythm365.org/URL/TheLeadEpisode54

William H. Sauer, MD, FHRS, CCDS, of Brigham and Women's Hospital is joined by guests Akshay Suvas Desai, MD, MPH of Brigham and Women's Hospital, and Sunil Kapur, MD of Brigham and Women`s Hospital to discuss how the Resynchronization–Defibrillation for Ambulatory Heart Failure Trial (RAFT) showed a greater benefit with respect to mortality at 5 years among patients who received cardiac-resynchronization therapy (CRT) than among those who received implantable cardioverter–defibrillators (ICDs). However, the effect of CRT on long-term survival is not known. We randomly assigned patients with New York Heart Association (NYHA) class II or III heart failure, a left ventricular ejection fraction of 30% or less, and an intrinsic QRS duration of 120 msec or more (or a paced QRS duration of 200 msec or more) to receive either an ICD alone or a CRT defibrillator (CRT-D). We assessed long-term outcomes among patients at the eight highest-enrolling participating sites. The primary outcome was death from any cause; the secondary outcome was a composite of death from any cause, heart transplantation, or implantation of a ventricular assist device.  https://www.hrsonline.org/education/TheLead https://www.nejm.org/doi/full/10.1056/NEJMoa2304542 Host Disclosure(s): W. Sauer: Honoraria/Speaking/Consulting: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific; Research: Medtronic Contributor Disclosure(s): A. Suvas Desai: Honoraria/Speaking/Consulting: Abbott, Novartis, AstraZeneca, BioFourmis, Regeneron, Alnylam Pharmaceuticals, Bayer Healthcare Pharmaceuticals, Cytokinetics, AxonTherapies, Avidity Biosciences, Medpace, Merck, New Amsterdam Pharma, Parexel, Roche Diagnostics, GlaxoSmithKline, NovoNordisk, Veristat, Verily/Google, Zydus, River2Renal, Research: Bayer Healthcare Pharmaceuticals, Abbott Medical, AstraZeneca, Novartis  S. Kapur: Honoraria/Speaking/Consulting: Medtronic, Novartis, Abbott, Biotronik This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode53

Deepthy Varghese, MSN, ACNP, FNP, of Northside Hospital, is joined by Dr. Mikhael F. El-Chami, MD, FHRS of Emory University, School of Medicine, and Dr. Rohit Mehta, MD, FHRS, with Advocate Health to discuss the study evaluated the preclinical performance and safety of retrieving chronically implanted dual-chamber leadless pacemakers (LPs). A total of 18 LPs were implanted in 9 ovine subjects, and after approximately 2 years, all LPs were successfully retrieved using a dedicated transvenous retrieval catheter. The retrieval procedure duration ranged from 2.5 to 36.4 minutes. Postretrieval analysis showed minimal tissue disruption at implant sites, and no significant device-related complications or injuries were observed. The study concludes that the retrieval of helix-fixation dual-chamber LP systems was safe and effective, paving the way for future clinical studies on LP retrieval. https://www.hrsonline.org/education/TheLead https://www.ahajournals.org/doi/10.1161/CIRCEP.123.012232 Host Disclosure(s): D. Varghese: No relevant financial relationships with ineligible companies to disclose. Contributor Disclosure(s): M. El-Chami: Honoraria, Speaking, and Consulting: Biosense Webster, Inc., Medtronic  R. Mehta: Honoraria/Speaking/Consulting: Medtronic, Biotronik, Stock Options, Privately Held: Huxley Biomedical, S4 Medical This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode52

Dr. Jason T. Jacobson, MD, FHRS of Westchester Medical Center-New York Medical College is joined by guest Jeffrey R. Winterfield, MD, FHRS of The Medical University of South Carolina, and Dr. Isabel Deisenhofer, MD, FHRS of German Heart Center Munich Department of Electrophysiology to discuss how the Omnipolar mapping provides greater specificity for late potentials, with higher sensitivity and specificity for deceleration zones and ventricular tachycardia isthmuses compared with bipolar mapping. https://www.hrsonline.org/education/TheLead https://www.heartrhythmjournal.com/article/S1547-5271(23)02408-6/fulltext Host Disclosure(s): J. Jacobson: Honoraria/Speaking/Consulting: American College of Cardiology, Zoll Medical Corporation, Research: Abbott, Phillips, Stock, Privately Held: Atlas 5D Contributor Disclosure(s): J. Winterfield: Honoraria/Speaking/Consulting: Abbott, Biosense Webster, Inc.  I. Deisenhofer: Honoraria/Speaking/Consulting: Abbott Medical, Biosense Webster, Volta Medical, Boston Scientific, Bristol-Myers Squibb, Research: Abbott, Daiichi Sankyo “This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365     https://www.heartrhythm365.org/URL/TheLeadEpisode51

Deepthy Varghese, MSN, ACNP, FNP, of Northside Hospital, is joined by guests Sandeep K. Goyal, MD, FHRS, Piedmont Heart Institute, and Andrea M. Russo, MD, FHRS, Cooper University Hospital. to discuss the article explores that development and validation of the HARMS2-AF score, a novel lifestyle risk assessment tool for identifying atrial fibrillation (AF) risk in the general population. Using data from the UK Biobank and Framingham Heart Study, the score, derived through Cox proportional hazards regression, includes variables like hypertension, age, body mass index, sex, sleep apnea, smoking, and alcohol. Physical inactivity and diabetes were not significant predictors. The score demonstrated effective predictive performance in both cohorts, outperforming existing models like Framingham-AF and ARIC, and comparable to CHARGE-AF. In conclusion, the HARMS2-AF score is a valuable tool for lifestyle-related AF risk identification, aiding in population screening and potential early intervention. https://www.hrsonline.org/education/TheLead https://academic.oup.com/eurheartj/article/44/36/3443/7205602 Host Disclosure(s): D. Varghese: No relevant financial relationships with ineligible companies to disclose. Contributor Disclosure(s): A. Russo: Honoraria, Speaking, and Consulting: Pacemate, AtriCure, Inc., Bayer Healthcare Pharmaceuticals, Sanofi, Medtronic, Biosense Webster, Inc., Biotronik, Abbott Medical, Boston Scientific, BMS/PFizer Alliance, Royalty Income: UpToDate, Inc., Research: Medtronic, Boston Scientific, Fellowship Support: Medtronic, Board Membership: ABIM.  S. Goyal: Honoraria, Speaking, and Consulting: Biosense Webster, Inc., Medtronic This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode50

William H. Sauer, MD, FHRS, CCDS of Brigham and Women's Hospital, is joined by Uyanga Batnyam, MD of the University of Washington and Usha B. Tedrow, MD, MS, FHRS of Brigham and Women`s Hospital to discuss the risks of radiofrequency catheter ablation for ventricular arrhythmias include emboli and bleeding complications but data on antithrombotic regimens are limited and guidelines do not specify a systematic approach. This study sought to assess embolic and bleeding complications in relation to pre- and postperiprocedure antithrombotic regimens. Stroke is a rare complication of radiofrequency catheter ablation for ventricular arrhythmia using ASA 325 mg/d as a minimal postprocedure regimen with more potent regimens for selected patients. https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/abs/10.1016/j.jacep.2023.10.011 Host Disclosure(s): W. Sauer: Honoraria/Speaking/Consulting Fee: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific; Research (Contracted Grants for PIs Named Investigators Only): Medtronic Contributor Disclosure(s): U. Batnyam: No relevant financial relationships with ineligible companies to disclose.  U. Tedrow: Honoraria/Speaking/Consulting: Medtronic, Inc., Biosense Webster, Inc., St. Jude Medical, Thermedical, Boston Scientific, Baylis Medical Company “This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode49

Deepthy Varghese, MSN, ACNP, FNP, of Northside Hospital, is joined by Sammy Khatib, MD, Ochsner Clinic, Foundation Program, and William Whang, MD, FHRS, Mount Sinai Hospital, to discuss the PULSED AF study investigated the impact of monitoring strategies on atrial arrhythmia (AA) recurrence after pulsed field ablation (PFA) in atrial fibrillation (AF) patients. The study employed various monitoring approaches, including 24-hour Holter monitoring and symptomatic trans telephonic monitoring, revealing that freedom from all AAs varied significantly based on monitoring strategy. PFA demonstrated substantial efficacy, yielding zero burden in 69.4% of paroxysmal AF and 62.2% of persistent AF patients, with a median burden below 9%. Notably, patients with PAF and less than 10% AA burden experienced clinically meaningful quality of life (QoL) improvements, while persistent AF patients showed QoL enhancements regardless of burden. The study suggests that the choice of monitoring protocol influences the ≥30-second AA recurrence endpoint and highlights the association between low AA burden post-PFA, improved QoL, and reduced healthcare utilization related to AAs. Notably, higher AA burden correlated with increased instances of repeat ablations and cardioversions. https://www.hrsonline.org/education/TheLead https://www.heartrhythmjournal.com/article/S1547-5271(23)02248-8/fulltext Host Disclosure(s): D. Varghese: No relevant financial relationships with ineligible companies to disclose. Contributor Disclosure(s): W. Whang: No relevant financial relationships with ineligible companies to disclose.  S. Khatib: Honoraria, Speaking, and Consulting: Biotronik, Abbott  “This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode48.

Peter F. Aziz, MD, FHRS, CEPS-P, of Cleveland Clinic Foundation, is joined by David Bradley, MD, FHRS, CEPS-P, of the University of Michigan and Henry Chubb, MA, MBBS, PhD, FHRS, CEPS-P of Stanford University, to discuss why the current guidelines do not support the use of MRIs in patients with epicardial or abandoned leads 2021 PACES guidelines, provide a 2b recommendation for MRIs in patients with abandoned, epicardial, or fractured leads. https://www.hrsonline.org/education/TheLead https://www.heartrhythmjournal.com/article/S1547-5271(23)02668-1/fulltext Host Disclosure(s): P. Aziz: No relevant financial relationships with ineligible companies to disclose.  Contributor Disclosure(s): D. Bradley: No relevant financial relationships with ineligible companies to disclose.  H. Chubb: No relevant financial relationships with ineligible companies to disclose.   “This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode47.

Deepthy Varghese, MSN, ACNP, FNP, of Northside Hospital is joined by Dr. Matthew Kalscheur, MD, of the University of Wisconsin and Dr. Hawkins Gay, MD, MPH, of Northwestern University Feinberg School of Medicine discuss the study aimed to validate the use of artificial intelligence (AI) in identifying paroxysmal atrial fibrillation (AF) from 12-lead electrocardiograms (ECGs) in sinus rhythm (SR). The AI algorithm was trained on ECG data from a single center, including patients with and without AF. The dataset comprised 494,042 ECGs from 142,310 patients. Testing the model on the first ECG of each patient showed an accuracy of 78.1%, an area under the receiver-operating characteristic curve of 0.87, and an area under the precision-recall curve of 0.48. Performance varied with AF prevalence, demonstrating higher precision in high-risk groups (30% AF prevalence) and lower precision in low-risk groups (3% AF prevalence). The approach was robust when externally validated in another hospital. In conclusion, the AI-enabled ECG algorithm effectively identified paroxysmal AF in patients in sinus rhythm, showcasing potential clinical utility, particularly in high-risk populations. https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacep.2023.04.008 Host Disclosure(s): D. Varghese: No relevant financial relationships with ineligible companies to disclose.  Contributor Disclosure(s): M. Kalscheur: No relevant financial relationships with ineligible companies to disclose.  H. Gay: No relevant financial relationships with ineligible companies to disclose.  “This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode46.

Dr. Michael S. Lloyd, MD, FHRS of Emory University, Dr. Faisal M. Merchant, MD, FHRS of Emory University School of Medicine, and Dr. David Duncker, MD, FHRS Hannover Heart Rhythm Center, Hannover Medical School, talk about what's new on the afib guidelines. https://www.hrsonline.org/education/TheLead https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193 Host Disclosure(s): M. Lloyd: Honoraria/Speaking/Consulting: Medtronic, Baylis Medical Company, Boston Scientific  Contributor Disclosure(s): F. Merchant: Officer, Trustee, Director, Committee Member: American College of Cardiology D. Duncker: Honoraria/Speaking/Consulting: Pfizer, Inc., Boston Scientific, Boehringer Ingelheim, Abbott Medical, AstraZeneca, Bayer Healthcare Pharmaceuticals, BMS/Pfizer Alliance, CVRx Inc., Medtronic, Zoll Medical Corporation, Sanofi “This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode45.

William H. Sauer, MD, FHRS, CCDS, of Brigham and Women's Hospital, David Chang, MD, of Brigham and Women's Hospital, Sunil Kapur, MD, of Brigham and Women's Hospital to discuss why Intraprocedural imaging is critical for device delivery in transcatheter left atrial appendage occlusion (LAAO). Although pivotal trials of LAAO devices were conducted using transesophageal echocardiography (TEE), intracardiac echocardiography (ICE) is an emerging imaging modality. This study compared outcomes after ICE- and TEE-guided Watchman FLX implantation in the SURPASS (SURveillance Post Approval AnalySiS Plan) nationwide LAAO registry. https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacep.2023.04.008 Host Disclosure(s): W. Sauer: Honoraria/Speaking/Consulting Fee: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific; Research (Contracted Grants for PIs Named Investigators Only): Medtronic Contributor Disclosure(s): D. Chang: No relevant financial relationships with ineligible companies to disclose.  S. Kapur: Honoraria/Speaking/Consulting: Biotronik, Abbott, Medtronic, Inc, Novartis 

Peter Aziz from Cleveland Clinic Foundation is joined by guests Maully J Shah, MBBS, FACC, FHRS, CCDS, CEPS, Director of pediatric EP at CHOP, and Professor of Pediatrics at the Perelman School of Medicine at University of Pennsylvania; Johannes von Alvensleben, MD., Director of Adult Congenital Arrhythmia Services at Children’s Hospital Colorado to discuss Implantable Subcutaneous Cardioverter-Defibrillators in Patients with Congenital Heart Disease. https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacc.2023.05.057 Host Disclosure(s): P. Aziz: No relevant financial relationships with ineligible companies to disclose. Contributor Disclosure(s): M. Shah: Board Membership: Journal of the American College of Cardiology, Research: Medtronic, Inc., Honoraria/Speaking and Teaching: Medtronic, Inc, Tenaya Therapeutics J. Alvensleben: No relevant financial relationships with ineligible companies to disclose.

William H. Sauer, MD, FHRS, CCDS, of Brigham and Women's Hospital, is joined by guests Michael G. Katz, MD, FHRS, of Morristown Medical Center and Victor Nauffal, MD, of Brigham and Women`s Hospital, to discuss the treatment options for high-risk Brugada syndrome (BrS) with recurrent ventricular fibrillation (VF) and how it is limited. Catheter ablation is increasingly performed, but a large study with long-term outcome data is lacking. We report the results of the multicenter, international BRAVO (Brugada Ablation of VF Substrate Ongoing Registry) for treatment of high-risk symptomatic BrS. Ablation treatment is safe and highly effective in preventing VF recurrence in high-risk BrS. Prospective studies are needed to determine whether it can be an alternative treatment to implantable cardioverter-defibrillator implantation for selected patients with BrS. https://www.hrsonline.org/education/TheLead https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.063367 Host Disclosure(s): W. Sauer: Honoraria/Speaking/Consulting Fee: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific; Research (Contracted Grants for PIs Named Investigators Only): Medtronic Contributor Disclosure(s): V. Nauffal: No relevant financial relationships with ineligible companies to disclose.  M. Katz: Stocks, Publicly Traded: Medtronic PLC, Abbott Medical, Novo Nordisk, Pfizer, Inc.; Owner/Partnership/Principle: Vision Valve Technologies, LLC.

Deepthy Varghese, MSN, ACNP, FNP, of Northside Hospital, is joined by guests Sheldon Cheskes MD, CCFP (EM), FCFP, Sunnybrook Research Institute, and Jason Grady, NRP of Northside Hospital to discuss the Association Between Number of Volunteer Responders and Interventions Before Ambulance Arrival for Cardiac Arrest. The study aimed to explore the relationship between the number of volunteer responders (VRs) arriving before Emergency Medical Services (EMS) and the likelihood of bystander cardiopulmonary resuscitation (CPR) and defibrillation during out-of-hospital cardiac arrests (OHCAs). The researchers analyzed OHCAs in two regions of Denmark and categorized them based on the arrival of VRs before EMS, with groups having 0, 1, 2, or 3 or more VRs. Using logistic regression adjusted for EMS response time, the study found that an increasing number of VRs arriving before EMS was associated with higher odds of bystander CPR and defibrillation. Specifically, the odds ratios (ORs) for bystander CPR and defibrillation increased as more VRs arrived before EMS, indicating a positive trend in the association. The study concluded that the presence of one or more VRs before EMS was linked to an increase in bystander CPR and defibrillation, with a notable trend towards increased defibrillation as the number of VRs increased. https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacc.2022.11.047 Host Disclosure(s): D. Varghese: No relevant financial relationships with ineligible companies to disclose.  Contributor Disclosure(s): S. Cheskes: Honoraria/Speaking/Consulting Fee: Zoll Medical Corporation J. Grady: Honoraria/Speaking/Consulting Fee: Abiomed

William H. Sauer, MD, FHRS, CCDS, of Brigham and Women's Hospital is joined by guests Michael A. Rosenberg, MD, FHRS, of University of Colorado Anschutz, and Jagmeet P. Singh, MD, PhD, FHRS, of Massachusetts General Hospital to discuss early detection of atrial fibrillation (AF) may help prevent adverse cardiovascular events such as stroke. Deep learning applied to electrocardiograms (ECGs) has been successfully used for early identification of several cardiovascular diseases. Deep learning of outpatient sinus rhythm ECGs predicted AF within 31 days in populations with diverse demographics and comorbidities. Similar models could be used in future AF screening efforts to reduce adverse complications associated with this disease.   https://www.hrsonline.org/education/TheLead https://jamanetwork.com/journals/jamacardiology/article-abstract/2810388   Host Disclosure(s): W. Sauer: Honoraria/Speaking/Consulting Fee: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific; Research (Contracted Grants for PIs Named Investigators Only): Medtronic   Contributor Disclosure(s): M. Rosenberg: No relevant financial relationships with ineligible companies to disclose.  J. Singh: Honoraria/Speaking/Consulting Fee: Medtronic, EBR Systems, Boston Scientific, Biotronik, Abbot, MicroPort Scientific Corporation, Cardiologs, Sanofi, CVRx Inc., Impulse Dynamics, USA, Implicity, Orchestra Biomed, Rhythm Management Group Corp, Medscape, Biosense Webster Inc., Notal Vision, iRhythm Technologies, Philips

Jason T. Jacobson, MD, FHRS, of Westchester Med Center-New York Med College, discusses the CAST trial with David J. Callans, MD, FHRS, CCDS of Hospital of the University of Pennsylvania, and Gerald V Naccarelli, MD, FHRS of Pennsylvania State University Milton S. Hershey Medical Center. Class IC antiarrhythmic drugs have been generally avoided in patients with any degree of coronary disease and any type of cardiomyopathy, whether or not they fit the inclusion criteria of the trial. For the past 3+ decades, the CAST trial results have been extrapolated to a broader population despite a lack of evidence. In this study, the authors retrospectively look at the safety of these agents compared with Class III drugs in patients with atrial fibrillation and varying degrees of CAD.  https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacep.2022.12.021 Host Disclosure(s): J. Jacobson: Honoraria/Speaking/Consulting Fee: American College of Cardiology, Zoll Medical Corporation; Research (Contracted Grants for PIs Named Investigators Only): Abbott, Phillips; Stocks (Privately Held): Atlas 5D Contributor Disclosure(s): D. Callans: Honoraria/Speaking/Consulting: Heart Rhythm Society, Thermedical, AtriCure, Inc., Abbott Medical, Biosense Webster, Volta Medical, Mediasphere Medical, Coherex, American College of Cardiology, Best Doctors, Bayliss Medical, Biotronik, Boston Scientific, Impulse Dynamics USA: Fellowship Support: Biosense Webster, Biotronik, Boston Scientific, Medtronic, Abbott; Other Financial Relationships: Wolters Kluver G. Naccarelli: Honoraria/Speaking/Consulting: Acesion, Sanofi, GlaxoSmithKline, Milestone, InCarda Therapeutics

Janice Y. Chyou, MD, FHRS, of Icahn School of Medicine at Mount Sinai is joined by guests Jonathan P. Piccini, Sr., MD, MHS, FHRS, of Duke University Medical Center, and Mintu P.Turakhia, MD, MS, of iRhythm Technologies and Stanford University to have A Discussion of Apixaban for Stroke Prevention in Subclinical Atrial Fibrillation. Subclinical atrial fibrillation is short-lasting and asymptomatic and can usually be detected only by long-term continuous monitoring with pacemakers or defibrillators. Subclinical atrial fibrillation is associated with an increased risk of stroke by a factor of 2.5; however, treatment with oral anticoagulation is of uncertain benefit. Among patients with subclinical atrial fibrillation, apixaban resulted in a lower risk of stroke or systemic embolism than aspirin but a higher risk of major bleeding.   https://www.hrsonline.org/education/TheLead https://www.nejm.org/doi/full/10.1056/NEJMoa2310234   Host Disclosure(s): J. Chyou: Honoraria/Speaking/Consulting Fee: McGraw-Hill, American Heart Association; Membership (Advisory Committee): American Heart Association   Contributor Disclosure(s): J. Piccini: Honoraria/Speaking/Consulting Fee: Biotronik, AbbVie, LivaNova, Boston Scientific, Phillips, Medtronic, Electrophysiology Frontiers, Abbott, UpToDate, Inc., Sanofi, Milestone Pharmaceuticals, Bayer Healthcare Pharmaceuticals; Research (Contracted Grants for PIs Named Investigators Only): Boston Scientific, Bayer Healthcare Pharmaceuticals, AMA, Abbott, Phillips, Element Science, Inc., iRhythm Technologies, NIH   M. Turakhia: Research (Contracted Grants for PIs Named Investigators Only): Bristol-Myers Squibb, FDA Circulatory System Devices Panel, American Heart Association, Bayer Healthcare Pharmaceuticals, Sanofi; Stocks (Board Membership): 100Plus; Employment: iRhythm Technologies

Bruce A. Koplan, MD, MPH, FHRS, of Brigham and Women's Hospital is joined by guests Andres Alonso Enriquez, MD, and Andrés Felipe Miranda-Arboleda, MD, of Queens University to discuss Efficacy Of Early Catheter Ablation For Atrial Fibrillation After Admission For Heart Failure.   https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacep.2023.05.038     Host Disclosure(s): B. Koplan: Honoraria/Speaking/Consulting Fee: GE Healthcare   Contributor Disclosure(s): A. Enriquez: No relevant financial relationships with ineligible companies to disclose.  A. Miranda-Arboleda: No relevant financial relationships with ineligible companies to disclose. 

William H. Sauer, MD, FHRS, CCDS, of Brigham and Women's Hospital is joined by guests Esseim Sharma, MD, of University Hospitals Cleveland, and Paul C Zei, MD, PhD, FHRS, of Brigham and Women's Hospital to discuss One-Year Outcomes Following Stereotactic Body Radiotherapy for Refractory Ventricular Tachycardia. Cardiac stereotactic body radiotherapy (SBRT) has emerged as a promising noninvasive treatment for refractory ventricular tachycardia (VT). The objective is to describe the safety and effectiveness of SBRT for VT in refractory to extensive ablation. For a select group of high-risk patients with VT refractory to standard therapy, SBRT is associated with a reduction of in VT and appropriate ICD therapies.   https://www.hrsonline.org/education/TheLead https://www.heartrhythmjournal.com/article/S1547-5271(23)02782-0/fulltext    Host Disclosure(s): W. Sauer: Honoraria/Speaking/Consulting Fee: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific; Research (Contracted Grants for PIs Named Investigators Only): Medtronic   Contributor Disclosure(s): E. Sharma: No relevant financial relationships with ineligible companies to disclose.  P. Zei: Honoraria/Speaking/Consulting Fee: Varian Medical Systems, Biosense Webster, Inc., Abbott; Research (Contracted Grants for PIs Named Investigators Only): Biosense Webster, Inc.; Stocks (Publicly Traded): Affera, Inc.